| NPI | 1063692440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA 20A11694) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA OP60106585) |
| 207V00000X Obstetrics & Gynecology (Licence: MI 5101016513) | |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2022-12-22 |